Typhoid

Typhoid fever is considered one of the most serious diarrhoeal diseases caused by certain bacteria (salmonella). The disease is widespread worldwide, but occurs more frequently in countries with poor hygienic conditions. Typhoid diseases that occur in Germany are usually brought back by travellers returning from tropical countries. As a prophylaxis, an oral vaccination can be administered in order to achieve protection among travellers.

There are two types of typhoid fever: the so-called abdominal typhoid fever (typhus abdominalis) and the typhoid-like disease (paratyphoid fever).

The number of new cases of typhoid fever per year is estimated at 22 million people, of whom about 200,000 die. Most of the deaths occur in the group of five to twelve year old children.

In Germany, the number of typhoid cases has been greatly reduced, which can be attributed to an improvement in hygiene conditions. According to the Robert Koch Institute, there were 69 new cases in 2008, all of whom recovered completely. Paratyphoid fever affected 86 people, with more than 80% of those infected having contracted the disease in other countries.

The trigger of typhoid fever is salmonella. A distinction is made between typhus abdominalis, which is caused by Salmonella enterica typhi, and paratyphoid fever, which is caused by Salmonella enterica paratyphi.

Transmission occurs largely through ingestion of contaminated water and food contaminated with feces (stool, urine). In rare cases, the infection can also be transmitted from person to person.

The time between infection and the appearance of the first symptoms is usually three to 60 days in the case of typhoid abdominalis (usually eight to 14 days) and about one to ten days in the case of paratyphoid fever.

The symptoms of typhus abdominalis and paratyphoid each manifest themselves differently:

Abdominal typhoid fever (typhus abdominalis).

• 39°C to 41°C fever, which can sometimes last up to three weeks
• Headache, pain in the limbs
• Drowsiness
• Abdominal pain
• Red-coloured spots on the abdomen, chest and back that are the size of a pinhead and do not itch.
• Possibly constipation in the early stages and pea-pulp-like diarrhea in the later stages

Typhoid-like disease (paratyphoid)

Paratyphoid runs a very similar course to typhoid abdominalis. However, the symptoms usually occur in a milder form.

• Nausea and vomiting in combination with watery diarrhoea
• abdominal pain and headache
• Fever of about 39°C, often combined with chills
• Reddish spots on the chest and abdomen
• Duration of the disease: about four to ten days

Typhoid and paratyphoid fever can easily be mistaken for an influenza infection. Malaria in travellers to tropical regions must be ruled out at all costs. Nevertheless, the diagnosis of typhoid fever should not be disregarded as a possible disease after an appropriate journey.

As a diagnostic method, an examination of the blood is normally carried out, which is considered to be very reliable. The blood count provides information about changes such as a reduced number of white blood cells. The pathogens can also be detected in the urine and stool.

If the bone marrow is examined, traces of typhoid and paratyphoid fever can even be detected after the disease has subsided.

Since typhoid and paratyphoid fever are very severe diseases, the affected person should be treated immediately with antibiotics, which are usually taken in tablet form. However, if the disease is particularly severe, it can also be administered in hospital in the form of an infusion. The therapy usually lasts for two weeks. In most cases, however, the fever decreases significantly after four to five days. Special attention should be paid to the administration of sufficient fluids and electrolytes, otherwise there is a risk of acute water loss. Strict hygiene should also be observed during the duration of the illness in order to avoid infecting contact persons.

Sometimes it can happen that patients still excrete small amounts of bacteria with their stool after they have overcome the illness (persistent excretors). In this case, treatment with antibiotics for several weeks is necessary. In case the patient has gallstones, the bacteria can settle in the gallbladder, which is why it is advisable to consider gallbladder removal.

If the therapy with antibiotics starts at an early stage, the chances of healing are very good. Sufficient fluid intake is important. If these conditions are met, the mortality rate is less than one percent.

However, if the disease is not treated, the lethality is 15 to 20%.

Abdominal typhoid fever can be well prevented with vaccination, which is advisable for people who stay in risk areas with poor hygiene conditions. An injection provides protection for about three years, whereas oral administration only provides protection for one year. There is no corresponding vaccination against paratyphoid fever.

Both diseases can be prevented with hygienic measures by avoiding raw or unpeeled food and not using water from wells and water pipes.